Provider Demographics
NPI:1295754232
Name:ISLAND PHYSICAL THERAPY
Entity type:Organization
Organization Name:ISLAND PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SLESIONA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:401-315-2995
Mailing Address - Street 1:19 GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-315-2995
Mailing Address - Fax:401-315-2996
Practice Address - Street 1:19 GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-315-2995
Practice Address - Fax:401-315-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
RIPT01004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709003969OtherGROUP
RI709003969OtherGROUP